Provider Demographics
NPI:1942715693
Name:MAYO, GABRIELLE ARGUELLES (MS, LAT,ATC)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:ARGUELLES
Last Name:MAYO
Suffix:
Gender:F
Credentials:MS, LAT,ATC
Other - Prefix:
Other - First Name:GABRIELLE
Other - Middle Name:DIEZ
Other - Last Name:ARGUELLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LAT, ATC
Mailing Address - Street 1:216 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24141-4326
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5414 COUGAR TRAIL RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:VA
Practice Address - Zip Code:24084-3841
Practice Address - Country:US
Practice Address - Phone:540-616-6374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-04
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260028602255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0126002860OtherVIRGINIA DEPARTMENT OF HEALTH PROFESSIONS
2000028507OtherBOC